Atypical Presentation of Metastatic Carcinoma Causing Patellar Destruction and Synovial Carcinomatosis: A Case Report.

Introduction: This case report describes the third documented example of primary esophageal carcinoma metastasizing to the patella and the first documented example of esophageal carcinoma metastasizing to synovium.

Case Report: A 67-year-old man with a history of metastatic esophageal carcinoma presents with right knee pain and an aggressive, destructive lesion involving the superior patella. Biopsy revealed esophageal carcinoma.

Effectiveness of Hospital-directed Wellness Interventions in COVID-19: A Cross-sectional Survey.

Introduction: Hospitals have implemented various wellness interventions to offset the negative effects of coronavirus disease 2019 (COVID-19) on emergency physician morale and burnout. There is limited high quality evidence regarding effectiveness of hospital-directed wellness interventions, leaving hospitals without guidance on best practices. We sought to determine intervention effectiveness and frequency of use in the spring/summer 2020.

The effect of older age on treatment outcomes in women with advanced ovarian cancer receiving chemotherapy: An NRG-Oncology/Gynecologic Oncology Group (GOG-0182-ICON5) ancillary study.

Objective: To assess the effect of age on overall survival (OS) in women with ovarian cancer receiving chemotherapy. Secondary objectives were to describe the effect of age on treatment compliance, toxicities, progression free survival (PFS), time from surgery to chemotherapy, and rates of optimal cytoreduction.

Methods: Women enrolled in GOG 0182-ICON5 with stage III or IV epithelial ovarian cancer (EOC) who underwent surgery and chemotherapy between 2001 and 2004 were included.

Right middle lobe syndrome after upper lobectomy: Role of the bronchial angle.

Background: Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome.

Method: All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome.

Successful treatment of rhino-cerebral mucormycosis with dual antifungal therapy and minimal surgical debridement.

The authors report the case of a 42-year-old female with history of type I diabetes mellitus and recent episode of diabetic ketoacidosis who presented with symptoms of epistaxis, gastrointestinal upset, hyperglycemia, confusion, and a cough. She was found to have rhino-cerebral mucormycosis with associated multi-focal strokes and a left internal carotid artery pseudoaneurysm. Her infection was successfully treated with dual-antifungal therapy consisting of liposomal amphotericin B and isavuconazole, and required only minimal surgical debridement.

CABG versus PCI in the Treatment of Unprotected Left Main Disease in Diabetics: A Literature Review.

The approach to left main coronary artery disease (CAD) in diabetic patients has been extensively debated. Diabetic patients have an elevated risk of left main disease in addition to multivessel disease. Previous trials have shown increased revascularization rates in percutaneous coronary intervention compared with coronary artery bypass grafting (CABG) but overall comparable outcomes, although many of these studies were not using the latest stent technology or CABG with arterial revascularization.

Feasibility of resection and plication "RAP" technique for management of medically refractory GERD in patients with altered gastric anatomy.

Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy.

The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature.

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic.

The impact of confirmed coronavirus disease 2019 (COVID-19) infection on ambulatory procedures and associated delays in care for asymptomatic patients.

Background: Since the reopening of ambulatory centers, minimal data has been reported regarding positive tests among patients undergoing ambulatory procedures, associated delays in care, and outcomes of patients previously positive for coronavirus disease 2019.

Methods: A retrospective observational case series of ambulatory procedures was performed. Records since the reopening of ambulatory centers in New York were searched for patients with positive coronavirus disease 2019 nasal swab results who underwent ambulatory procedures.

Proposed Mechanism-Based Risk Stratification and Algorithm to Prevent Sudden Death in Epilepsy.

Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in young adults with uncontrolled seizures. First aid guidance to prevent SUDEP, though, has not been previously published because the rarity of monitored cases has made the underlying mechanism difficult to define. This starkly contrasts with the first aid guidelines for sudden cardiac arrest that have been developed based on retrospective studies and expert consensus and the discussion of resuscitation challenges in various American Heart Association certificate courses.

Causes and Effects Contributing to Sudden Death in Epilepsy and the Rationale for Prevention and Intervention.

Sudden unexpected death in epilepsy (SUDEP) claims the lives of one in every thousand epileptic patients each year. Autonomic, cardiac, and respiratory pieces to a mechanistic puzzle have not yet been completely assembled. We propose a single sequence of causes and effects that unifies disparate and competitive concepts into a single algorithm centered on ictal obstructive apnea.

Outcomes of press-fit uncemented versus cemented hip arthroplasty in the oncologic patient.

Background And Objectives: Cemented hip arthroplasty is considered the standard of care for treating both osteoporotic femoral neck fractures and pathologic disease of the proximal femur due to the ability to achieve strong fixation in poor quality bone. There is minimal literature evaluating uncemented arthroplasty for pathologic disease of the proximal femur. This objective of this study is to compare outcomes of patients undergoing cemented and uncemented arthroplasty of the proximal femur for an oncologic indication.

Follow-up results of myositis patients treated with H. P. Acthar gel.

Objectives: Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterized by proximal muscle weakness. H. P.

Innovations in Endoscopic Therapy for Gastroesophageal Reflux Disease.

Minimally invasive endoscopic antireflux therapies are critical for bridging the gap between medical and surgical treatments for gastroesophageal reflux disease (GERD). Although multiple endoscopic devices have been developed, perhaps some of the most exciting options that are currently evolving are the full-thickness suturing techniques using widely available and low-cost platforms. Full-thickness endoscopic suturing can allow for a highly durable recreation of the anatomic and functional components of a lower esophageal sphincter, which are deficient in patients with GERD.

A Multicenter Study of Pediatric Macular Holes: Surgical Outcomes With Microincisional Vitrectomy Surgery.

Purpose: Pediatric macular holes occur often related to trauma and rarely require surgical intervention. The purpose of the present study was to evaluate outcomes of microincisional vitrectomy surgery.

Methods: A multicenter retrospective consecutive case series was conducted of pediatric patients undergoing surgery for macular hole repair.

Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location.

Aim: To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.

Methods: Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings.

Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience.

Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown.  This is an international case series of patients who underwent endoscopic suturing for bleeding PUD.

Bevacizumab and re-irradiation for recurrent high grade gliomas: does sequence matter?

Purpose/objectives: We report the outcomes of the largest cohort to date of patients receiving both bevacizumab (BEV) and fractionated stereotactic radiotherapy (FSRT) for progressive or recurrent high grade glioma (HGG). Furthermore, the sequence of these two treatment regimens was analyzed to determine an optimal treatment paradigm for recurrent HGG.

Materials/methods: After Institutional Review Board approval, patients with pathologically confirmed WHO grade III anaplastic astrocytoma (AA) or IV glioblastoma multiforme (GBM) glioma who subsequently underwent re-irradiation at recurrence with FSRT were retrospectively reviewed.

Functional Decline and Resilience in Older Women Receiving Adjuvant Chemotherapy for Breast Cancer.

Objectives: To analyze self-reported changes in physical function in older women with breast cancer receiving adjuvant chemotherapy.

Design: Secondary analysis of the Cancer and Leukemia Group B (CALGB) 49907 prospective randomized clinical trial.

Setting: CALGB institutions in the United States.

Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study.

The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared NAVIGATE to usual Community Care in a cluster randomized design involving 34 sites and 404 patients. This article describes the approach to training and implementing the NAVIGATE program at the 17 sites (including 134 practitioners) randomized to provide it, and to evaluating the fidelity of service delivery to the NAVIGATE model. Fidelity was evaluated to five different components of the program, all of which were standardized in manuals in advance of implementation.

The survival benefit of neoadjuvant chemotherapy and pCR among patients with advanced stage triple negative breast cancer.

Triple negative breast cancer (TNBC) is an aggressive subtype that accounts for 15-20% of cases, with a higher incidence of relapse/death. Even with adjuvant chemotherapy, the 5 year distant metastasis-free survival rate remains low. A total of 452 tumor registry patients with TNBC and no evidence of metastatic disease were identified over the period of 1996-2011.

Sarcoidosis of the external nose: the role of pharmacologic rhinoplasty in diagnosis and treatment.

Subcutaneous sarcoidosis is a rare manifestation of a systemic disease. Sarcoidosis most often affects the pulmonary system but can also affect sinonasal tissues including the cutaneous and subcutaneous layers. It can be suspected in patients who may or may not have a prior diagnosis of sarcoidosis but who develop nodules or lesions over the nasal dorsum after trauma or rhinoplasty.

Efficacy and safety of adrenocorticotropic hormone gel in refractory dermatomyositis and polymyositis.

Aim: To evaluate the efficacy, safety, tolerability and steroid-sparing effect of repository corticotropin injection (RCI), in an open-label clinical trial, in refractory adult polymyositis (PM) and dermatomyositis (DM).

Methods: Adults with refractory PM and DM were enrolled by two centres. Inclusion criteria included refractory disease defined as failing glucocorticoid and/or ≥1 immunosuppressive agent, as well as active disease defined as significant muscle weakness and >2 additional abnormal core set measures (CSMs) or a cutaneous 10 cm Visual Analogue Scale score of ≥3 cm at least three other abnormal CSMs.